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Helping kids stay mentally healthy through COVID-19

Everybody freak out! Or don’t. As some of you may have heard, there is currently a type of coronavirus (COVID-19) that is spreading rapidly and negatively impacting individuals and systems around the world. As this novel narrative plays out it is hard to guess what the future of this virus will look like or the impact it will have on our families and communities. However, it is safe to say that it will, if it has not already, impact our day-to-day functioning dramatically. Anxiety is a natural reaction to these changes and the information flooding in and especially when some, if not most, of that information is sensationalized.

Children rely on us to help them navigate their physical and emotional worlds. Children will likely experience fear, frustration, and a variety of other intense emotions as the impact of the pandemic continues to be felt. The following strategies are things I think will help children maintain resilience in the face of this unique stressor.

Maintain Routines

Maintaining routines and daily ritual is important. Maintaining healthy sleep habits for your children is at the top of this list. Pandemic or not- research has found that as a society we are sleeping less than we should and that the sleep we are getting is of lower quality. For example, one Australian study published in the journal Pediatrics analysed every reputable study they could find on children’s sleep duration over the past 100 years and found that on average children’s sleep has dropped 0.71 minutes a year. Now, that 45 or so seconds may not seem like a lot, but over that 100-year period has added up to over an hour and almost 10 percent of the sleep children used to get despite increasing demands on their brains and bodies.

We could spend a whole book on the many necessary things healthy sleep provides developing brains and barely scratch the surface. However, as it relates to anxiety, the bottom line is that less sleep and lower quality sleep reduces a child’s ability to manage emotions.

Routines are important to sleep quality. Where possible, maintain a similar bedtime and wake pattern. This may be challenging with changes in schooling and schedules but maintaining a regular sleep pattern in times of increased stress is essential. Part of the reason for this is that sleep works on a 24-hour (or “circadian”) clock that in most people allows itself to slip back easier than to come forward. As those sleep onset times shift, the patterned movement through sleep stages can struggle to adapt. As a result, children experience decreased amounts of necessary REM and deep sleep leaving them more fatigued and less able to manage the situations of heightened arousal.

In addition to maintaining routines, here are some additional tricks to helping kids get a good sleep. Humans have learned to sleep in dark and cooler environments. The darker the room- the better the sleep. For children with a fear of the dark, strategies that minimize the visible range in the room, such as dividers segmenting the room or small tents that can be placed over the bed can help appease the fear of guessing what’s in the room in a more sleep congruent way than night lights. As it relates to temperature, ideal sleep climates are somewhere around 18 degrees celsius. Providing kids with the opportunity to cool at night can naturally boost the quality and quantity of their sleep.

Where possible maintain other routines in your life as much as possible during times of increased stress such as family reading times, games nights, meal times and others. Providing a sense of predictability and order can help them feel that despite the many changes around them in the world they are safe and that we can control their outcomes in a safe way. Make sure basic needs like hunger and thirst are met in predictable ways.

Talk to Kids About COVID-19

Providing children with accurate information is important and could help them make decisions that keep themselves and those around them safe. Further, children’s creativity will fill in gaps in information or make interpretation of information they receive. These interpretations can lead to significant anxiety as they are often wrong or incomplete. Providing young people with complete and accurate information appropriate to their developmental age is essential. It could be tempting to underplay the potential severity of COVID-19 to children to appease anxiety in the moment but doing so may influence the decisions they make in ways that could put themselves or others at risk. Similarly, sensationalizing information to scare kids into compliance may have negative emotional consequences. Present children information from verified sources and be prepared to present that information over multiple conversations over time.

When engaging in conversations about COVID-19 with children ask them what they know and what they think about the things they see happening. Provide them a safe place to be heard and seen prior to responding or teaching. Take the opportunity to gently correct information that they have heard that is not true. For example, children who have heard reports of death related to COVID-19 could be informed that though it is a serious illness, that death and especially death in young people, is incredibly rare.

Be honest about the things we know and things we don’t know. For example, we don’t know how long current safety measures will be in place. Rather than guessing at a length of time- respond to the root of the concern and grieve the things they are missing and acknowledge the anxiety of not being able to predict what the future may look like. Explore these emotions with them.

Children respond better to active commands or things that they can do as opposed to asking them to stop doing things or avoid things. For example, teach kids strategies on how to wash their hands, give them fidgets or safe things to play with instead of touching their faces, and train them how to cough or sneeze in ways that are safe.

Be Physically and Emotionally Available to Your Children

With social isolation strategies at the forefront of most prevention plans, physical availability may be a default with increasing closures of schools and recreation. However, in addition to physically being present for your child, being emotionally present for them is of equal or greater importance. Have conversations that safely help your children to explore their complex feelings. For example, a simple three step conversation that I like with children is summed up in the acronym ACE. This is an adaptation of a process first described by Daniel Hughes. The ACE conversation breaks down into Acceptance, Curiosity and Empathy.

Acceptance refers to acknowledging where a child is emotionally. We want our children to be happy. It is uncomfortable to see them in pain. Acceptance refers to overcoming our knee-jerk “fix-it” reaction when a child is in pain. For example, were a child to approach us and say “I’m really scared I’ll get sick” a typical response might be “it’s okay tiny human- no one around here is going to get sick.” This response would come from a place of wanting to stop their worry. However, it is also not entirely accurate as we can’t predict the future. Further, this response discredits their genuine and reasonable emotional response. An accepting emotional response would be “You are really scared because of all the news you have been hearing about the Coronavirus.” This response accepts that they are having an emotional experience and rather than trying to move past that or change the emotion, it sits with it. If we can’t safely sit with their emotions how can we expect them to?

Curiosity refers to the process of exploring their feelings with them. To do this I advocate using open ended questions. Open ended questions require a descriptive rather than a confirmative answer. For example, questions that start with “what” or “how” are typically open-ended questions. Following an acceptance of the emotion, an open question like “tell me more about what is going on for you?” can be a great way to sit deeper into the emotion with a child and better understand what is influencing how they are feeling.

Empathy refers to the imagination of another’s experience. Once we have noticed and acknowledged how a child is feeling and explored where those feelings come from, we may now be in a place to better imagine why they are feeling the way they are. An example of an empathic statement would be “I can understand why you might feel frustrated if you think that you will not be able to see your friends again.”

Following this conversation pattern positions us in a great place to then help children with strategies to respond to their emotions. We can then talk about healthy ways to respond to the sadness of not seeing friends or the fears that we ,or those we love, will get sick.

Maintain Social Connectedness in a Responsible Way

This is a tough one to promote given the direct advice in many communities to practice ”social distancing.” As such, this would likely fall into the category of ‘do the best you can while still making smart decisions based on reputable sources.’ However, maintaining a healthy physical distance is not the same as socially isolating ourselves. To practice emotionally healthy strategies purely from a perspective of trauma informed practice, maintaining or re-establishing social connectedness is vital. For some, this may include weathering the storm and waiting until better social options become more prudent and reliable. The point is to do what you can to maintain a sense of connectedness.

While still on “lock down”, explore connection practices that take advantage of technology. Though not a replacement for face-to-face connection, these may help maintain relationships and maintain a sense of connectedness in the face of this unique situation. Where safe, remain as active as possible in small safe groups. Within your own family unit, do things together! Social connectivity is active and involves doing things. Passive activity, like parallel TV viewing should be balanced with more active social activity that includes reflective involvement.

Practice Empathy

Anxiety works to help promote safety and value in life. It does this through moving us towards things good for us and away from things bad for us. It is natural to experience negative emotion towards things that are potentially harmful to us… like getting sick. Our fear for ourselves or those we care about can be taken in by our emotional system and fed out as anger towards those perceived as a threat. It’s easy to start viewing others as selfish, reckless, stupid or as thoughtless. It is easy to feel repulsed by them and respond angrily. Pay attention to your feelings that disconnect you from others and stop you from trying to see the world through their lens.

Practice empathy and compassion with our children. Imagine why others might be acting the way they are, how they may be feeling, and walk our children through similar reflective processes. Empathy is the imagination of another’s experience. There is a lot of anxiety and pain in the world around us now and imagining how others may be experiencing that will better equip us to help where we can.

A Note on Trauma

Psychological Trauma refers to a human response to overwhelming experience. No event is inherently traumatic. Whether or not an event is traumatic depends on how a person processes and emotionally experiences stimuli from the world. Traumatic stress is most commonly a response to events perceived to be life threatening and in which a person feels powerless. Helping your children to feel safe, to feel that they have control in areas of their lives and to feel that parents can keep them safe minimize the risk of traumatic stress in the face of intense emotional situations.

The three foundational principles to overcoming traumatic stress responses are safety, meaning making and reconnection. These three principles are present in all of the suggestions above. Routines build a sense of safety and control, safe communication can help children make sense of the world and their emotions and reconnection or maintaining connection helps people continue to find reward in the world in the face of traumatic stress.

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